Provider Demographics
NPI:1851391718
Name:MONTGOMERY, SUZANNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:E
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 42878
Mailing Address - Street 2:CORNERSTONE FAMILY PHYSICIANS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46242-0878
Mailing Address - Country:US
Mailing Address - Phone:317-581-8888
Mailing Address - Fax:317-705-7179
Practice Address - Street 1:8902 N. MERIDIAN STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:40260
Practice Address - Country:US
Practice Address - Phone:317-581-8888
Practice Address - Fax:317-705-7180
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100216280Medicaid
INC25654Medicare UPIN
219090AMedicare PIN
IN100216280Medicaid